Patient-Surgeon, Rebel-Doctor

As a surgeon, I am 100% responsible for my patients. As a patient, I learned the hard way that absurd bureaucratic, governmental interference in the patient-physician relationship is lethal. I learned that as a patient-surgeon, I must actively protect my patients from the insanity of government-run medicine.

When I arrived for my mastectomy, an arm band was placed on my wrist. The arm band had a bar code. I don’t read bar code, do you? Everything that happened to me from that point on involved swiping my barcode. I awoke from surgery to my surgeon assuring me that everything had gone flawlessly. I thanked him and God. The hospital was full, so I was stuck in Recovery for hours. When I finally settled into my hospital room, I was startled by a warm, wet sensation- that of bright red blood flooding from my bandages and drains through my gown and into the sheets. My pulse quickened, and I grew faint. My surgeon returned emergently and adeptly stopped the hemorrhaging. He was superb. We were perplexed.

Flashback: As a young medical school faculty member in the early 1990′s, I felt honored to serve on our county hospital’s “Quality Assurance” committee. The University and County Hospital district had discovered they could get easy money from Medicare and Medicaid to supplement what they got from the State and County if only they did a “few little extra things” in return and complied willingly. Federal Government (CMS) required that we create “indicators” which could be monitored, as if to prove or judge that we were doing something worthy of getting paid, with their money, to treat our patients (as if they actually knew anything about medicine). In reality, they were trying to justify their existence and gain control over us.

I naively helped produce indicators and unquestioningly followed subsequent orders from the “powers that be”- being that I was a type A, pleaser, rule-following, too-trusting-in-government, doctor. The ensuing years beheld a massive transfer of power from physicians and patients to bureaucratic government entities and their pals, the hospitals. Government held the medical purse, and now government holds the power over our lives. I am partly to blame for the sophomoric laminated “5 moments of hand washing” and “fire triangle” signs posted in my OR as lame responses to lame indicators.

Flash Forward: As a seasoned surgeon in private practice, amidst the storm of my battle against Obamacare, I was diagnosed with breast cancer. Untested rules and regulations (new indicators which now came from top down) were set in place. These had never been tested on patients but were established by government fiat as “the new way of doing things”, and money would go to only those who complied. The perfect storm for medical disasters was brewing.

Obamacare operates through a series of perverse incentives and a few carrots which are ultimately traded for many sticks each passing year. For example, CMS will penalize hospitals that have readmissions. Likewise, CMS will not pay surgeons for their services if patients develop post op problems (even if the problems are acknowledged consequences of life-saving surgery). These are the new top down indicators. Combine Obamacare’s “pay for performance”, with HIPAA, and the requirement for “meaningful use” electronic medical records, and it is medical tsunami time.

To prevent monetary penalization for readmissions from postop DVT’s, many hospitals opted to require that orthopedic patients receive post-operative anticoagulation as a standing order. To avoid not getting paid for surgery if a patient gets a post op DVT, the surgeons agreed. To comply with HIPAA, hospitals came up with absurd ways to identify patients without calling them by name, and out of fear of hefty fines, again, doctors went along. Electronic medical records (EMR) were “deemed” excellent and not only mandated for physicians, but government actually bribed physicians with $44,000 per doctor to adopt EMR. The safety and truth of any of this was never tested. It is all just false speculation from medical Utopia.

Back in the real world, after significant blood loss and sensing something not right, I determined to stay alert. In the middle of the night, the nurse came in, opened her med cart, scanned my arm band and then the electronic chart, and told me to take the meds. I asked what they were and determined they were not indicated for me. To her dismay, I refused. I left the hospital as soon as I could, in less than 24 hours, fearing further problems. We ultimately discovered that in the recovery room, my barcode had been inadvertently scanned to a different patient’s chart-that of an elderly man having orthopedic surgery- a patient for whom the hospital required anticoagulation for DVT prevention because of Obamacare style medicine.

Once my wristband was on, no one asked my name again. The electronic record, the impersonal HIPAA-born barcode, and the mandated DVT prophylaxis to prevent not getting paid, all culminated in an event that almost killed me. Had I not been a physician, who knows what else might have happened had I stayed in the hospital and continued to get someone else’s meds.

At my last two operations, instead of being assigned a barcode, I was given a sticky note labeled “A” for one and “B” for the other. When the nurse came out and called “Patient A” or “Patient B” , at least one or two elderly, hearing impaired or nervous, patients stood up with me to head back to the OR. Let’s restore sanity. I have a name. I am not a barcode, an A, or a B. I am a unique patient.

It is our duty as physicians to stand for tested, proven, individualized medicine and against the false assertions of untested government group medicine. It is time to say “No, We Won’t” to those who defile the practice of Hippocratic medicine. If we won’t stand up for our patients and profession, who will?

I am no longer naively trusting of the government and its deadly false assertions and mandates. I will not do those “few little things” just to get paid. I will not comply with the insanity and inhumanity of Obamacare. And now, more than ever, I am 100% empowered to fight for the safety of my patients and the sanctity of the patient-physician relationship. I am now a rebel doctor. What are you?

Kris Held MD is an ophthalmologist in private practice. You can follow Dr. Held on Twitter @kksheld

Comments

Despite the name “Accountable Care Act” the system is neither accountable nor affordable, and it is not designed to offer actual care. It is time for ALL physicians to stand up to the bullies in DC and in countless boardrooms with a singular statement, “My profession is NOT for sale!” How many will? http://www.asurgeonsheart.com is my personal effort to ignite that fire, and I whole heartedly support your efforts, Kris. I know your father is very proud of you.

Dr. Held, great article. I hope the tide is turning. Doctors don’t like the way things have turned out in medicine, yet they refuse to do anything about it. I hear a lot of “tough talk” in the locker room every time some new, insulting mandate is put in place by CMS or the hospital, but yet everyone complies like the sheep they are. Doctors talk the talk, but they don’t walk the walk. Hell, a lot of them don’t even complain, so it’s no wonder that the powers that be keep coming at us. That’s what bullies do, they don’t respond to appeasement and they won’t leave you alone if you don’t stand up to them.

As for me, my timed, board certificate in plastic surgery “expires” in 2016. I have NOT complied with the MOC requirements and I’m not going to. I just recertified in general surgery and was informed that from now on, I must start submitting MOC mandated data if I wish to recertify in 10 years. I WILL NOT comply! I all of us could simply gather the courage to stop following the rules that none of us had a hand in crafting, we would help ourselves and our patients. Just say “NO” and stop sending these idiots your hard earned money!

This breast surgeon must defend herself to the NSQIP gods regularly regarding my refusal to blindly administer DVT prophylaxis to patients for whom it is NOT indicated! And your story is the reason why….

Well written article. I like that many of us are finally waking up to the absurd system we work in. The problem is that we are still behind the curve. The fundamental problem is a demographic lead financial crisis. We cannot as doctor continue using 21st century technology in a 19th century system. We have lost control of the system. We need to resist as a collective. Unfortunately we have allowed others to tell us how to organize and who to vote for. We needed to have been involved. We needed to be apart of the financial discussions. Our population is rapidly aging and someone has to pay for the extravagant spending in our system. We need to acknowledge our part in the breaking of the system. It was great and still is great for some. For many of us it has not and continue to not function. I hope we have woken up and will now look with open minds and propose the changes that are need to rescue our sinking system.

Isn’t it a shame that it took you have a hospital to realize what the rest of us have gone through!?! Doctors need to be more human and aware! shame on you for only realizing when it was your body that was in jeopardy! I hope you become a better doctor then you obviously weren’t.

As a nurse who has seen both sides of the issue, first I commend you for the well written story, second I say same on the hospital for taking the person out of the care and thirdly I say we cannot throw out our common sense for the sake of compliance or non compliance. I long for the day when all humans will have access to affordable care without government interference but I do understand that our system has lost it’s checks and balances in favor of profit for all who can grab it. Health professionals everywhere who really care are in a quandary. However we do have to guard against blindly following the crowd.